The Machinist

Introduction

Released in the UK in 2005, The Machinist was directed
by Brad Anderson and stars Christian Bale in one of the most
committed performances to be seen in cinema. Bale loses so much
weight for the part of Trevor Reznik, more than 4 stones in a
matter of months, that his skeletal form is almost too difficult to
watch at times. The film opens with the main protagonist, Reznik,
in an extremely disturbed state of mind, seemingly disposing of a
body rolled in carpet. What follows is the back-story to this
scene, as we learn that Reznik has suffered from a year of crushing
insomnia and dramatic weight loss. The film ends with us
understanding the cause of his initial insomnia and the subsequent
development of his paranoid psychosis.

With a tagline to the film that states ‘A little
guilt goes a long way...’ we find ourselves firmly in the realm of
psychiatric illness for the whole of the 98 minutes and it gives
the viewer an opportunity to experience the confusing and
frightening world of paranoia at close quarters. The screenplay was
written by Scott Kosar, who states that he was influenced by
Dostoyevsky’s The Double: A Petersburg Poem, a short
novel that describes the inner struggle of its protagonist, who
starts seeing his double everywhere, as his mental state
deteriorates. It is worth mentioning that some scenes in The
Machinist are disturbing, despite it being rating as a
15.

The Film

I do not intend to reveal the entire plot of The
Machinist, but wish to consider the way in which the film
provides us with suggestions about Reznik’s mental state. This
begins with the choice made by the director, throughout most of the
film, to use a cinematic atmosphere of low light and grimy
surroundings, which contribute to an overall tone of hopelessness
and despair. The musical score also reinforces what we see of
Reznik’s fearful, persecutory state of mind for much of the film.
But it is the gaunt, haunted skeletal appearance of Bale himself
who manages to convey the complexity of his character, racked with
guilt, denial and increasing persecutory anxieties, that makes this
an extraordinary visual account of a mental illness unfolding
before our very eyes.

After the initial opening scene described
above, we learn that Trevor Reznik is single and works as a machine
operator at the local factory. We discover that he visits a
prostitute, called Stevie, regularly and that he is a friend to her
as much as a client. Early in the film, she is clearly concerned
about both his weight loss and his distracted mental state and
suggests that he see a doctor. However, he refuses to seek help of
any kind. The management at his workplace also express concern
about his weight loss and mental state, asking him if he is ‘doing
drugs’. To them he states that he has got a lot on his mind, but
he’s dealing with it.

His distracted mental state then leads to an
awful accident at his work in which a colleague loses a limb,
resulting in the other workers turning against Reznik for his
‘weird’ state of mind. His paranoia in this context appears real
and justified. In the investigation of the incident, Reznik
confesses to having been distracted by another worker, called Ivan,
leading him to discover that there is no such person employed by
the factory. However, Ivan continues to pursue Reznik, who begins
to feel increasingly persecuted. He begins to neglect his
day-to-day responsibilities and personal care and in a downward
spiral of despair also loses his job. But he continues to turn to
Stevie as someone he can trust until, finally, she too becomes a
part of his persecutory world and she throws him out of her flat. A
parallel storyline, with particular significance to the film,
concerns Reznik’s late night trips to the airport coffee bar where
he has become well known to the waitress there who works the night
shift. Interestingly, these scenes are bathed in light and seem to
offer some temporary way out of the darkness for Reznik.

As the film progresses the boundary between
truth and delusion becomes completely blurred for Reznik and the
viewer. Certain everyday objects, like the cigarette lighter in his
truck, appear to take on a special significance only understandable
after the final scenes of the film. We are not sure what to believe
until we are given several clues that Ivan is in fact a part of
Reznik himself, hounding him until he finally makes the right
choice about something he has done. Only when he takes full
responsibility for his earlier action does he get any resolution of
his guilt and can at last fall into a deep sleep. The film
provides us with the final piece of the psychological puzzle at its
very end but some viewers may have managed to collect enough clues
before then to reach the correct conclusion for themselves.

Relevance to the field of Mental Health

For any professional engaged in carrying out mental state
assessments, this film offers the opportunity to enter the
persecutory world of an individual and to experience the blurring
of boundaries between truth and delusion that so disturbs people
suffering from a paranoid psychosis. An excellent article on
paranoia, entitled Helping patients with paranoid and
suspicious thoughts: a cognitive–behavioural approach by Daniel
Freeman and Philippa Garety (Advances
in Psychiatric Treatment (2006) 12:
404-415) could be read alongside a
viewing of this film for enriched learning.

The Machinist offers not only a
brilliant springboard to teach about the experience of paranoia but
also presents the opportunity to consider the differential
diagnosis in someone who presents with such symptoms and to examine
the predisposing, precipitating and perpetuating factors that might
be used in constructing a psychodynamic formulation. Further
discussion about psychodynamic formulations is available in a
two-part article published in Advances in Psychiatric Treatment
entitled Teaching of psychodynamic formulation to psychiatric
trainees(2005)
11: 416-423and(2006)
12: 92-99 both by Chris Mace and Sharon
Binyon.

With regards to Reznik, one could suggest that
his premorbid personality, shaped perhaps by the absence of his
father from a young age, coupled with his single status and lack of
intimacy, has predisposed him to develop a depressive episode, in
which he suffers from extreme anorexia and chronically impaired
sleep, which in turn further impair his cognitive functions. We
come to understand that the trigger for his illness was his spur of
the moment decision to flee from a traumatic event generating huge
guilt. His depression steadily worsened over a year without any
professional help, until he develops a severe psychotic depressive
episode with mood congruent paranoid delusions, visual
hallucinations and second person auditory hallucinations. I suggest
that Ivan represents a projection; the mental mechanism described
by psychoanalysts whereby a person attempts to get rid of
unacceptable impulses or parts of the self by externalising
them.

The Machinist could also offer a
platform for discussion about the topic of insomnia and chronic
sleep deprivation. A very good and broad
introduction to the topic of insomnia and its causes
can be found on the NHS choices website. It is important to note
that although Reznik states that he hasn’t slept for a year, we
actually watch him having a brief lapse into sleep that lasts a few
seconds one night. In reality, the sleep deprivation record is
thought to stand at 266 hours (a little over 11 days) achieved on
live webcam in 2007 by a 43 year old Cornishman called Tony Wright,
as this BBC report describes. The Guinness Book of
Records stopped acknowledging attempts at sleep deprivation prior
to his achievement because of the negative consequences for
health.

The Machinist could definitely be
used to teach students from various backgrounds about persecutory
delusions and abnormal perceptions and it illustrates the
importance of obtaining an independent history from an informant,
whenever possible, when interviewing someone suffering from
paranoid symptoms. I would recommend this film for anyone seeking
to work in adult mental health.

Finally, after mentioning the first national
medical film festival, Medfest 2011, in my last post, I was
fortunate to attend the St George’s event as a panellist. The three
contrasting films shown made for a very interesting evening of
viewing and discussion, one of which, called Shadow Scan,
tells the harrowing story of an over stressed, drug addicted and
depressed, self-harming junior doctor. Written and directed by
doctor turned filmmaker, Tinge Krishnan, Shadow Scan won a
BAFTA in 2001. Lasting ten minutes, it is available to watch on
YouTube and could definitely be considered alongside The
Machinist in a discussion about the filmic techniques used to
create an atmosphere of despair and depression in a character.
Shadow
Scan can be viewed in its entirety here and for
anyone interested in hearing more about the festival, there is an
excellent review at the Lancet online, May 18, 2011.